基于古今文献的中药临床“禁忌慎”评估要素探讨

Evaluation Elements of Clinical ’Prohibition’ ’Contraindication’,or ’Use with Caution’ in Chinese Medicine Based on Ancient and Modern Literature

针对中药禁忌用语禁用、忌用或慎用(以下简称"禁忌慎")临床评估存在较大争议的现状,提炼"禁忌慎"的评估要素,为"禁忌慎"的划分与临床合理用药提供参考。该文系统梳理本草、方书、医经、药典、临床专著、论文等古今代表性中医药文献,围绕用药风险与获益,凝炼提出"禁忌慎"的评估要素与思路。总结发现"禁忌慎"的评估要素包括药性特征、机体病症证以及用药配伍量程等。在特定用药条件下评判药物"禁忌慎"时,可采用先判别药物"禁忌"性质,再区分药物"禁忌慎"差异的思路。从药物自身、机体状态和临床用药3个层面去评估中药临床"禁忌慎"是可行的,三者在实际执行的过程中具有相对性。

In view of the current controversy in the clinical evaluation of the terms of ’prohibition’’contraindication’,and ’use with caution’,the present study summarized their evaluation elements to provide references for the classification of ’prohibition’ ’contraindication’,and ’use with caution’ and clinical rational medication of drugs. Based on the ancient and modern representative traditional Chinese medicine(TCM)literature,such as the records on herbal medicines and prescriptions,medical classics,pharmacopoeia,clinical monographs,and papers,this study proposed the evaluation elements and the underlying ideas of ’prohibition’’contraindication’,and ’use with caution’ around the risks and benefits of medication. The results indicate that the evaluation elements of ’prohibition’ ’contraindication’,and ’use with caution’ include TCM property,syndrome,symptom,TCM compatibility,dosage,and treatment course. When evaluating ’prohibition’ ’contraindication’,and ’use with caution’ of TCM under specific conditions of medication,we can determine the properties of prohibited or contraindicated drugs prior to figuring out the differences in ’prohibition’ ’contraindication’,and ’use with caution’. It is feasible to evaluate the clinical ’prohibition’ ’contraindication’,and ’use with caution’ in TCM from Chinese medicine,body,and the clinical medication,which are correlated with each other in the practice implementation.